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General NPI Number Information
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NPI Number | 1659186435
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Entity Type | Individual
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Provider Name | MILLIE FOREMAN
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Gender | Female
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Dates
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Enumeration Date | 02/10/2025
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 103 NORTH AVE STE 1
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51503-1613
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Country | US
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Telephone | 712-828-1914
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Fax |
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Provider Business Mailing Address
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Address Line | 2345 280TH ST
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City | MISSOURI VALLEY
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State | IA
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Zip | 51555-8017
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Country | US
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Telephone | 712-216-2117
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 124351
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License Number State | IA
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